How Insurers use Artificial Intelligence to Determine Personal Injury Damages
January 13, 2002
Over the last few years the use of the computer program, Colossus, to adjust personal injury auto accident claims has spread, virus-like, throughout the insurance industry. This article is to introduce you to what it is and how it impacts what value the insurance company will put on your motor vehicle personal injury claim.
Colossus is an artificial intelligence program which purports to be able to place a value on certain types of personal injury claims using over 10,400 parameters to screen data entered by the adjuster. None of those parameters take into account the human factors that are the most important to an honest evaluation of the change in the quality of life or pain and suffering element of the personal injury claim. The program is part of a comprehensive cost containment package put together by Computer Services Corporation for the purpose of reducing payouts on injury claims to increase insurance company profits. The results have been damaging to the injured claimants but lucrative for the insurance companies.
Around 60% of all insurance companies writing automobile insurance in the United States now use the Colossus program to determine the value of personal injury claims. Two of the three companies with the largest market shares in Washington state, Farmers Insurance and Allstate Insurance use Colossus. Not surprisingly, these same insurers had the most consumer complaints filed against them with the Washington State Insurance Comissioner’s office in 2002. The evidence suggests Allstate and Farmers are also the most aggressive in rating adjuster performance on their ability to conclude cases within the Colossus value range.
The program itself is not the villain alone, as Colossus determines values based on the “tuning” or additional database parameters entered by each specific insurance company. Once the database is in place Colossus is ready to accept data on the specific claim under consideration. The adjuster inputs data about a claim through an interactive series of questions as prompted by Colossus. The range of questions is broad as it is designed to encompass all the key factors involved in a claim from income loss to medical expenses, diagnosis, ratable permanent injury, liability, impact, use of safety equipment, prior conditions, etc. The several pages of data entry required make operator error or “garbage in garbage out” a distinct possibility.
The first law of Colossus is the medical records rule. These are the source for most pieces of information that can be entered and credited toward the value of the claim. The program divides personal injury care into phases – initial, subsequent and future. If it isn’t written down in your medical or other care records it does not exist and did not happen to you. The verbiage used in the records can make a difference in how an injury or finding is perceived, entered into the computer and the impact it has on the claim. For example, in Colossus-speak only bulge and herniation are recognized as warranting the additional settlement value associated with having received a disc lesion type injury in the auto accident.
Any element of subjective complaints or examinations that is not listed in the medical or other care records as specific findings, diagnosis, treatment plans will not be considered when assessing the value of the personal injury claim. Some of these pieces of critical information can be provided through a supplemental narrative report or file note.
Changes in Activities of Daily Living (ADL) are entered as “Activities Under Duress”(AUD). AUD are defined as activities that must be undertaken out of necessity but which are impacted by pain and partial disability from the personal injury. They must be spelled out specifically in medical records as to how they impact the injured person at home, work, school or otherwise.
Certain diagnosis have inherent value and add money toward the settlement offer in a musculoligamentous, or neck and back injury case. These include muscle spasm, range of motion loss, headaches, dizziness, vision disturbance, anxiety, depression. Findings such as sensory changes to touch or pin prick, sensitive areas on palpation, neck guarding, abnormal head posture, cervical lordosis and muscle weakness will be recognized by Colossus. Permanent ratable impairment is considered by Colossus when assessed by a medical doctor (not doctors of chiropractic) and computed according to the AMA guidelines for permanent impairment. Loss of enjoyment of life as an element of general damages is only credited if ratable impairment is present.
It is also important to note that the computer adjuster program does have some limitations in how it is supposed to be used by the insurance companies. Colossus is not designed to evaluate personal injury claims involving brain injury, psychological injury, dental injury (though it does include TMJ injury) or residual scarring. Where one or more of these conditions are clearly documented in the care provider records a human evaluation of what the personal injury claim is worth outside the computer program is supposed to occur.
Attorneys in Washington as well as across the country have, and are, filing cases against the insurance companies who use Colossus as the determining factor in deciding the value of an automobile personal injury claim. At some point these cases may succeed in extending the reach of consumer protection and /or insurance bad faith laws and codes to the point where modifications will have to be made in claims handling using Colossus industry wide and the for the most aggressive insurers, Allstate and Farmers in particular.
The complexities of Colossus driven evaluation of personal injury claims means documentation by providers needs to be to a “gold standard.” It also means a consultation with a skilled personal injury attorney is important to advance the interests and recovery of the injured persons in this hostile and inhuman personal injury claim environment. A skilled attorney can assist the care provider in providing adequate documentation, then present that documentation and other evidence necessary to feed Colossus and obtain the best result for the injured person.